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Cytologically Proved Malignant Pleural Effusions : Distribution of Transudates and Exudates

Zakaria Assi; James L. Caruso; James Herndon; Edward F. Patz, Jr.
Author and Funding Information

Affiliations: From the Department of Internal Medicine, Duke University Medical Center, Durham, NC.,  From the Department of Pathology, Duke University Medical Center, Durham, NC.,  From the Division of Biometry, Duke University Medical Center, Durham, NC.,  From the Department of Radiology, Duke University Medical Center, Durham, NC.

Affiliations: From the Department of Internal Medicine, Duke University Medical Center, Durham, NC.,  From the Department of Pathology, Duke University Medical Center, Durham, NC.,  From the Division of Biometry, Duke University Medical Center, Durham, NC.,  From the Department of Radiology, Duke University Medical Center, Durham, NC.

Affiliations: From the Department of Internal Medicine, Duke University Medical Center, Durham, NC.,  From the Department of Pathology, Duke University Medical Center, Durham, NC.,  From the Division of Biometry, Duke University Medical Center, Durham, NC.,  From the Department of Radiology, Duke University Medical Center, Durham, NC.

Affiliations: From the Department of Internal Medicine, Duke University Medical Center, Durham, NC.,  From the Department of Pathology, Duke University Medical Center, Durham, NC.,  From the Division of Biometry, Duke University Medical Center, Durham, NC.,  From the Department of Radiology, Duke University Medical Center, Durham, NC.


1998 by the American College of Chest Physicians


Chest. 1998;113(5):1302-1304. doi:10.1378/chest.113.5.1302
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Abstract

Purpose: This study attempts to determine the distribution of transudates vs exudates in pathologically proved malignant pleural effusions and the necessity for cytologic studies in patients with a transudative effusion.

Materials and Methods: A retrospective review of all cytologically positive malignant pleural effusions was performed at Duke University Medical Center over an 18-month period. All effusions were characterized as a transudate or an exudate based on standard criteria, including lactate dehydrogenase and protein values.

Results: Ninety-eight patients with a mean age of 62 years were identified as having a cytologically positive malignant pleural effusion and blood chemistry values available to distinguish an exudate from transudate. Ninety-seven patients (99%, 95% confidence interval; 0.94 to 0.99) had criteria for an exudative effusion. One patient (1%) with diffuse metastatic lung cancer had a borderline transudate and was in congestive heart failure at the time of thoracentesis.

Conclusions: Cytologically positive pleural effusions for malignancy are almost always exudates. Cytologic evaluation for malignant cells of a transudative pleural effusion is not recommended.


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